The goal of this study is comparison between the using of ultrasound guidance versus anatomical guidance in femoral artery access for endovascular treatment of chronic lower limb ischemia, by assessment of first pass success rate, total number of attempts required for access, rate of accidental venipunctures, rate of PFA puncture and time to sheath insertion, and assessment of post procedural puncture site complications defined as bruises or hematoma formation.The study found that US guidance is superior to anatomical guidance in femoral artery access in endovascular treatment of chronic lower limb ischemia in reducing access time, total number of punctures, and number of incidental venipuncture, the incidence of PFA access and incidence of local bruises.

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Objectives: Critical limb ischemia (CLI) occurs due to progressive obstructive nature of atherosclerosis disease. Nowadays, there is widespread use of endovascular revascularization procedures for restoration of blood flow in CLI. The aim of this study is evaluation of the efficacy of endovascular intervention in patients with critical limb ischemia.Methodology: This is a prospective observation study. It included patients presenting with chronic atherosclerotic critical lower limb ischemia to the department of vascular surgery, in Beni-Suef University Hospital or Al-Agouza Police hospitals, during the period of October 2017 till April 2020. Patients included were patients with chronic critical limb ischemia eligible for endovascular intervention. Excluded ones were patients with severe tissue loss of the foot beyond salvage, orthopnea, and whose anatomical lesion was distributed to TASC II D classification. Study end points were limb salvage, procedural complications, and conversion to open surgery. A written consent was obtained from participants for data disclosure. Detail of the procedure (endovascular intervention), its indications, methods, risks, and outcome were explained for every patient. Results:The current study included 220 patients. The mean age was 60.65 years ± 10.8 years, 143 males (65%) and 77 females (35%), 132 patients (60%) were smoker, 127 were hypertensive, 176 patients (80%) were diabetic, 55 cases (25%) had Coronary Artery Disease (CAD), 11 (5%) patients suffered from COPD, 11 cases (5%) had end stage renal disease (ESRD), and 44 cases (20%) had renal insufficiency. The mean follow up period was about 9 months. 36 (16.4%) patients were distributed into TASC II A, 76 (34.5%) were distributed to TASC II B, and 108 (49.1%) patients were distributed to TASC II C. 182 (82.7%) patients had their limb saved while 38 (17.3%) of cases had either their limbs lost (23 patients), suffered from peri-procedural mortality (5 patients) or open surgery conversion was decided (10 patients). Statistical correlation showed that predictors of limb loss were hypertension, CAD, and COPD patients. Conclusion:Endovascular revascularization is effective for patients with critical limb ischemia, where it provides a high limb salvage rate (LSR). Some variables are associated with worse outcome like hypertension, COPD and CAD.